Decoding the Natural History of Alcohol-Related Recurrent Acute Pancreatitis and Progression to Early Chronic Pancreatitis: Clinical, Biochemical, and Imaging Insights from a Single-Center Retrospective Study in France

<b>Background:</b> Recurrent acute pancreatitis (RAP) of alcoholic etiology is a major risk factor for chronic pancreatitis (CP). Early chronic pancreatitis (ECP) represents an intermediate stage where structural changes can be identified before advanced disease develops. The 2019 Japanese Pancreas Society (JPS) imaging criterion, defined as >3 dilated side branches on magnetic resonance imaging (MRI), provides a standardized approach for early diagnosis. <b>Objective:</b> To assess the prevalence of MRI-positive findings per JPS imaging criterion in patients with alcohol-related RAP and to identify clinical predictors of progression. <b>Methods:</b> We retrospectively analyzed 26 patients with alcohol-related RAP admitted between January 2023 and December 2024. All underwent MRI 4-8 weeks post-discharge. Patients were classified as MRI-positive or nonMRI-positive per JPS imaging criterion. Clinical, biochemical, and imaging parameters were compared using univariate and multivariate analyses. <b>Results:</b> Nine of twenty-six patients (34.6%) were MRI-positive per JPS imaging criterion. These patients had a significantly higher number of RAP episodes (<i>p</i> = 0.021). Disease duration also differed between groups (<i>p</i> = 0.034). No significant differences were observed in computer tomography severity scores or biochemical markers. In multivariate analysis, only the number of RAP episodes was associated with MRI-positive status (OR 4.00, 95% CI 0.79-20.3, <i>p</i> = 0.09). <b>Conclusions:</b> MRI-positive findings per JPS imaging criterion were present in one-third of alcohol-related RAP patients. Having ≥3 RAP episodes was the most consistent risk factor for structural progression. Systematic MRI during the inter-critical phase may allow early identification of high-risk patients and inform closer surveillance.